Y5S-64871-80937

4 vaccinations 8 coded responses 43 check-ins 8 free-text entries 5 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 320 / FL
Registered: 2021-01-27

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-01-27
Registered in v-safe
2021-01-27
Dose 1 — Moderna
2021-01-27
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-31
Survey response — days 1–6 daily, dose 1
MedDRA: Rhinorrhoea — Feeling: Good · Fatigue or tiredness

Free text: Runny nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Survey response — days 1–6 daily, dose 1
MedDRA: Oropharyngeal pain — Feeling: Good

Free text: Slight sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-03
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-17
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-24
Dose 2 — Moderna
2021-02-24
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-05
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-10
Survey response — day 14, dose 2
MedDRA: Burning sensation, Ear discomfort, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Burning sensations in mainly left side of neck and behind left ear. Doctor thinks it might be mild shingles without rash and is treating it as such. · Healthcare visit (other): My primary physician

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-17
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-24
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-31
Survey response — day 35, dose 2
MedDRA: Back pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Upper right side back pain...could be stress related

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-07
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-26
Survey response — 3 months, dose 2
MedDRA: Arrhythmia, Atrial fibrillation, Hospitalisation — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Afib · Healthcare visit (other): 1 night stay in hospital getting heart to normal rhythm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-26
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-10
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-08-25
Survey response — 6 months, dose 2
MedDRA: Anaemia, Atrial fibrillation — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: AFib. Anemia

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-25
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-23
Dose 3 — Moderna
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Itching · None

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-30
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-06
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-13
Survey response — day 21, dose 3
MedDRA: Cough, Dyspnoea, Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Cough. Harder to breathe. Tired

MedDRA releases: 2024-11 · check-in free text available
2021-11-20
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-27
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-04
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-22
Survey response — 3 months, dose 3
MedDRA: Anaemia, Endoscopy small intestine — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Severe anemia · Healthcare visit (other): Outpatient dbl balloon enteroscopy (b)(6)

MedDRA releases: 2024-11 · check-in free text available
2022-01-22
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-01-26
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-01
Dose 4 — Moderna
2022-04-18
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-25
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-04-29
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-06
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-13
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-01
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-09-30
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-01
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-27	Moderna
2	2021-02-24	Moderna
3	2021-10-23	Moderna	No
4	2022-04-01	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-10	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-03-31	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-05-26	Successful 2021-06-10	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-08-25	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-01-22	Successful 2022-01-26	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 3 — days 1–6 daily, dose 1

2021-01-31

Systemic reaction (other): Runny nose

2021-02-01

Systemic reaction (other): Slight sore throat

Release 5 — day 14, dose 2

2021-03-10

Symptoms: Burning sensations in mainly left side of neck and behind left ear. Doctor thinks it might be mild shingles without rash and is treating it as such.

Healthcare visit (other): My primary physician

Release 6 — day 35, dose 2

2021-03-31

Symptoms: Upper right side back pain...could be stress related

Release 8 — 3 months, dose 2

2021-05-26

Symptoms: Afib

Healthcare visit (other): 1 night stay in hospital getting heart to normal rhythm

Release 9 — 6 months, dose 2

2021-08-25

Symptoms: AFib. Anemia

Release 10 — day 21, dose 3

2021-11-13

Symptoms: Cough. Harder to breathe. Tired

Release 11 — 3 months, dose 3

2022-01-22

Symptoms: Severe anemia

Healthcare visit (other): Outpatient dbl balloon enteroscopy (b)(6)

redacted (b)(6)

Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that survey response. The CDC cut some text off at about 250 characters: symptoms in every release, and the other two fields in releases 9-12. Those entries are marked "cut off by CDC".

MedDRA terms by release

Field	Preferred term	2021-09	2023-04	2024-11
HCVO	Arrhythmia	✓	✓	✓
HCVO	Endoscopy small intestine	·	·	✓
HCVO	Hospitalisation	✓	✓	✓
HCVO	Office visit	✓	✓	✓
SD	Anaemia	✓	·	✓
SD	Atrial fibrillation	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Burning sensation	✓	✓	✓
SD	Cough	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Ear discomfort	✓	✓	✓
SD	Fatigue	·	·	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓

✓ active code · ○ coded but marked inactive · blank = not in that release